Stuck in Park

The lady I met yesterday lived in a lake house. She was bruised from a recent fall, and spoke but would get stuck on her words. Her daughter was quick to tell me that she was not suffering from dementia, she just has difficulty getting the words out.

A three-wheeled walker sat across the room from her as she sat in a patio chair with arms on it. As I sat on the couch she quipped something about me sinking in and the couch swallowing me up. I smiled back at her without saying anything about my own battle with being able to stand and walk.

Because of her difficulty getting up and off of furniture her daughter had the entire house retrofitted. She had wheelchair and walker access to the kitchen, bathroom, and bedroom areas without any barriers. She had also planned to go shopping for lift chairs within the week.

This isn’t the first client with Parkinson’s Disease that I’ve met this month or this year. Neurological disorders like this have a tendency to feel like a prison sentence. I don’t want to be overly dramatic, but if your brain is unable to get signals to your muscles it can feel like you are stuck in park and unable to get going.

The tremors that often accompany this disease get worse with movement. The ability to swallow often grows slow and drooling can be a constant difficulty. When movement is easy you can enjoy activities, but only knowing that in a moment you may again be struggling. Falls can be frequent and unavoidable. It is important to understand it is not due to weakness. It is due to the lack of communication between the client’s thoughts and the relays that signal muscle movement. It’s like trying to put the car in drive without having the proper lubricant in the transmission. It locks up.

The medication used to treat this disease does not cure it, but should relieve the symptoms. There are several medications used by doctors to help with symptoms, but the most common treatment is with Carbodopa/Levodopa. This medication has a short half-life, or short (3-4 hour window) time acting in the brain. Once taken most people feel the effects in 15 minutes and have to plan on their next dose because they will also feel their movements slow as the medication leaves their system.  

I tell our HCA’s, to avoid hurting themselves, be very patient. Allow the client to do as much as possible on their own. Use a count before assisting with a transfer so that the client is not stiff and resistant to the movement causing you to strain.  I give them permission to start and restart each movement in order to maximize the client’s abilities.

As caregivers and nurses it is easy to run low on patience. This particular group of client’s really need us to find a way to re-fuel and take our time with everyday tasks. Their health and wellness depends on them being able to maximize their good days. So, give them what they need. Patience and kindness as they get the gears turning and work through the moments where movement seems hard.

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Who Is The Hero

When I walk into a new client’s home it can be easy for me to look around and think… “Same story, different house.” The story goes a little like this. A relatively healthy person gets sick or has an injury. They hold out as long as possible before asking for help. When their needs exceed the limits of their available volunteer support they call us (or their caregiver calls us.)

When I go to meet with the client and their caregiver, I know that I am not a very important player in their story. They will grow much closer to their Home Care Aide, HCA, than they will to me. A few of them will realize that they are talking to the company owner and appear to give me their respect for gracing their home. Others will ask questions like… “Why are you seeing clients?” I can only say, “Its what makes me happy.”

It is really not about me though. I offer my expertise. I know how to ask questions and how to solve many of their problems, but once this is done it will be other hands who will guide them and care for them in their life story.

Our Staff Coordinator will use our Care Connects system to find the appropriate HCA. Our Office Manager or Administrator will agree or disagree and call the best possible HCA in to discuss the client’s needs. An introduction will be arranged under the best circumstances and the HCA will meet the client for the first time. First impressions being what they are… we hope everything will go well and we have inserted a great supporting character into the life story of our client.

A really good HCA knows that they are also playing a supporting role in a client’s life story. A few of them think that they should be the hero, but the best HCA’s have a way of making their client’s feel like they are the main character and hero in their own story. The client’s ability to find a happy ending should be the result of calling on us to help them to rise to the challenge of this chapter in their life.

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Love To Walk

I am an amputee, and when I don’t have my prosthetic on, I am at a disadvantage. It’s hard for me to remember running races or being able to play kick ball or even stepping up a curb without stopping to adjust to the terrain. People who know me can attest to the fact that I always have my prosthetic on. I walk. I move myself every day, because I love being able to walk.

Mrs. James is a client I met almost a year ago. It broke my heart when I heard her say that she has been in a wheelchair for six years. Her life has been changed because she is not able to stand and walk more than a few steps. Her problem started after a surgery. Pain kept her from getting up and moving. Since she hasn’t walked in such a long time she has become weak and uses a wheelchair.

Lets take a walk down memory lane. When was the last time you stumbled while walking? I often hear people joke about having two left feet, or the ever popular, “did you see that crack in the side walk jump up and grab my foot?” If you hear yourself or someone else say these things frequently then its time to pay attention. Most people can use a device to make walking easier or safer. Others need more intense action.

Being able to walk is taken for granted by most of us. From the moment we take off on two legs as a toddler till we have something happen that threatens that ability. There are a few things that can be done to improve or regain the ability to walk.

The first step, is believing. It is important to get your mind made up that you will be able to improve your strength and balance. If you don’t see it happening, then it will impact your progress. It has to become so important to you, that any amount of effort, energy or pain is worth it to you.

The second step, is doing exercises that will impact your ability to walk. There are specific actions that will impact balance and posture and improve the smoothness of your movements. These actions can be assigned by your therapy staff or you can talk to us about joining a free Matter of Balance class. Our Home Care Aides can work with you to help you accomplish your goals as well.

Strength only improves when you do real work. As someone speaking from experience, walking is worth the work. Keep your head up, tighten your core muscles and swing your arms. You may not move fast enough to feel the wind in your hair, but you will go places and see the people that you love.

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Social Responsibility

Social responsibility is a red hot subject in business circles right now. The culture we live in has been demanding transparency and a feel good experience from employers.

One of the biggest motivators for me to start my own business was related to the positive experience I wanted to create for my clients and employees. I got a feel good experience creating jobs and writing payroll checks. More recently my feel good experience has been related to our philanthropic activities.

As an example, we have been making contributions to Shiawassee Respite Volunteers of Shiawassee for about eight years. Though this organization provides a similar service as ours, we see it as an investment in our goal to see people living in their home. You can find more information about their organization at www.shiarespite.org.

Other organizations we have made donation too include; local schools yearbook or athletics, Alzheimer’s Association Walk, fireworks celebrations, domestic violence shelters, community partnerships, hospital foundations, etc.

This year we are doubling our commitment to invest in local causes. We are also pushing our employees to join our volunteer program. If you walk into our offices across the state you will see our TV’s showing a slide encouraging our employees to volunteer and to report their volunteerism. I believe our greatest asset is the great big hearts our employees have.

I look forward to reporting at the end of the year more about our success as a company to give back to our community as well as being able to motivate our staff to give time and talent to improve our communities.

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Happiness and Touch

Touch is so central to our humanity that it is hard to even imagine living without it. For example, if a child is born blind, they can grow up and have a completely full and normal life. They will be cognitively normal, psychiatrically normal, and not have profound problems. However, in an environment where social touch is deprived, a child will develop terrible psychiatric problems, digestive problems and immune deficiency according to Neuroscientist David Linden.

So, how touched are you? I had a client tell me not to worry about her. She said, “I’m not lonely,” even though she lived alone. She lived on the family farm and spent most of the 30 minutes each week that I visited telling me stories of her family and the farm.

I imagine she was living off the touches she had given and received all of her life. Researchers from the University of California, Berkeley say that a hug releases a hormone called Oxytocin. This hormone is sometimes referred to as the “love hormone.” Researchers say it’s got a lot to do with aging and has reparative and anti-aging benefits.

Just to add a bit more science to the conversation, touch, as a neuroelectric impulse, is recorded in two different areas of the brain. Scientists that study pain teach that signals are found to stimulate the brain in the primary somatosensory cortex. This is where the degree of sensation is deciphered. At the same time this same signal is processed in the posterior insula creating an emotional aspect to each and every sensation.

So just imagine that someone is stroking you on the arm. If they stroke really slowly, it doesn’t feel loving. It feels like a crawling bug. It’s a repellent. And if someone strokes very quickly, it doesn’t feel loving either. There is a range of speeds in which a caress feels good. You might think the brain is programmed to make the decision of what feels good, but that’s not the case. If you actually record electrical activity from these nerve endings they send more signals for caresses that feel the best per Dr David Linden.

He goes on to say that both painful and pleasurable touches are emotional and powerful. They mark experiences that are important in life. Each memory is made important by the signals sent by touch. We record it as memory and somehow underline it as important.

For all of us, the experience of touch is intrinsically emotional. This shows in the way we talk. Common English expressions like, “I’m touched by your concern,” “That’s rough,” or “He rubs me the wrong way,” are so common we don’t realize they are references to the sense of touch. Statements like; “It’s a sticky situation,” or “That’s enough of that coarse language,” brings up emotional responses because we are wired to feel touch as more than just tactile signals.

So, what do we do when our tactile thresholds are significantly increased by age or illness? In an article “Effects of Aging On Touch” by M M Wickremaratchi states that damage to the skin and its neuro receptors can decrease the signals sent to the brain. And decreased signals are expected to be related to the lower levels of hormones that produce happiness.

Some of us may shy away from persons who are older or are ill. I would encourage the opposite. See the value of the life experiences they have and get close enough to touch them, or touch the things they care about. One thing my client cared about was a flower that she kept next to her chair. We watched it grow and blossom together. It was a touch point for her and I. A picture of the flower is still in the photos I keep.

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Shouting Too Much

I find myself shouting too often. It is the unfortunate side effect of working with clients who do not hear well. Their hardness of hearing makes it difficult for me to give them important information about their plan of care and it can be frustrating.

I remember a gentleman that Care N Assist provided in home care for, for three years until his death in 2013. He would frequently say, “I don’t shive a git.” His wife would look at me with worry as he was giving up control of his life. His hardness of hearing had gotten so bad that even with his hearing aides in he could barely understand a common conversation. When I would begin to talk about his medical concerns, well it wasn’t usually successful.

Common causes of hearing loss in adults can either be inherited from parents, or acquired from an illness, caused by ototoxic (ear damaging) drugs, exposure to loud noise, tumors, head injury, or the aging process according to the American Speech Language Hearing Association. The loss can occur by itself or with tinnitus (ringing in the ears).

For those of you that enjoy the details, I found the information on the website for the Hearing Loss Association of America very clear and easy to read. It has details about the three types of hearing loss and their possible treatments. The following link will take you to their sight… http://www.hearingloss.org/content/types-causes-and-treatment

I imagine most people of age and distinction have no control over their hearing loss. It is something that comes with the territory. Most of them will be seen by an audiologist and fitted with hearing aids. Their insurance may cover the cost, or they may have to save up in order to afford them.

The importance of being able to communicate, to be understood and to hear others is ultimately what matters. The entire healthcare industry depends on our patients’ ability to hear and understand their condition and treatment.

My frustration, as a registered nurse, comes when I have a client who has given up. No matter how loud I shout instructions, I really just want them to hear me say that I care about them and want to help. Hearing loss doesn’t have to be an end for our client’s social lives. Creative solutions can be found and services like our In Home Care exist to support that.

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Which Caregiver Experiences Burnout

I sat with a client and her daughter a short time ago. We talked about plans to allow Care N Assist to provide support services so the daughter could take time for herself. She was apprehensive. She couldn’t make up her mind about the days and times she wanted help. She was only meeting with me because her  sisters had told her to do this.

I sat with another client and her daughter yesterday. This daughter knew that she needed help. She wrote out a list of days and times that she needed help with before I arrived. It was her mother, the client, who was upset and didn’t think it was necessary for her to have anyone else help.

In both of these circumstances the caregivers encountered some conflict. The expectations that they had of themselves as they faced their circumstances are very different, but they are both at risk of caregiver burnout.

It was an inner conflict for one and an external conflict for the other. Feelings of burnout usually start out as we encounter circumstances that are out of our control. You may feel like you do not have the expertise. You may be worried that you are not strong enough to physically do all that is needed. It is possible that the client’s wishes are in conflict with your wishes for them.

Please don’t think that I am comfortable with the idea of caregiver burnout. In the absence of physical or financial limitations I believe in the value of caregiving. As human beings we are capable of doing much more than some would think. I believe that love and helpfulness while our lives change makes us mature and unselfish.

Both of these qualities take a lifetime to develop, but as a wise friend once told me, it is not selfish for us to take care of ourselves. The airplane stewardess always instructs you to put on your own oxygen mask before helping others, right?

With this being said, it is smart for you to do what you can for yourself before you do the work of caring for someone else. Try these things to take care of yourself; exercise, meditation, eating smart foods, and distraction.

If you need expertise or support you can hire help from an in home care agency like Care N Assist. In partnership with other health care workers we can create a plan that resolves most conflicts. You can have caring partners helping you along the way, and this can go a long way to preventing caregiver burnout.

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